Provider Demographics
NPI:1790067866
Name:ALLERGY, ASTHMA, IMMUNOLOGY CLIFTON PARK
Entity Type:Organization
Organization Name:ALLERGY, ASTHMA, IMMUNOLOGY CLIFTON PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMP
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-724-1060
Mailing Address - Street 1:939 ROUTE 146
Mailing Address - Street 2:SUITE 810
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3662
Mailing Address - Country:US
Mailing Address - Phone:518-724-1060
Mailing Address - Fax:518-724-1070
Practice Address - Street 1:939 ROUTE 146
Practice Address - Street 2:SUITE 810
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3662
Practice Address - Country:US
Practice Address - Phone:518-724-1060
Practice Address - Fax:518-724-1070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITALCARE MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235119207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty